The prognostic role of the albumin-corrected anion gap (ACAG) in cirrhotic patients with invasive fungal infection (IFI) remains unclear. This retrospective cohort study aimed to investigate the association between ACAG and 28-/90-day mortality in this high-risk population. A retrospective cohort study was conducted at Beijing Ditan Hospital, including patients with cirrhosis complicated by IFI who were admitted between January 2009 and December 2021. ACAG was calculated using initial anion gap and albumin measurements within 24 h of admission. Patients were stratified into high and normal ACAG groups by an ACAG cutoff of 20 mmol/L. The primary outcomes were 28-day and 90-day all-cause mortality. Cox proportional hazards regression models and Kaplan-Meier survival analysis were employed to assess the association between ACAG levels and mortality outcomes. Subgroup analyses were performed to explore the consistency of the association. The prognostic value of ACAG was assessed by receiver operating characteristic (ROC) curve analysis. A total of 313 cirrhotic patients with IFI were enrolled. Patients with high ACAG (≥ 20 mmol/L) had significantly higher 28-day (36.44

Background Severe fever with thrombocytopenia syndrome (SFTS) is a life-threatening tick-borne viral disease with high mortality and limited treatment options. Understanding its transmission routes is essential for effective prevention and control. Case presentation: We report a case of a 55-year-old woman who developed high fever, malaise and diarrhea five days after being bitten by a Mustela sibirica (Siberian weasel). SFTS was diagnosed on day 12 via metagenomic next-generation sequencing (mNGS) of peripheral blood. Despite timely antiviral and supportive treatment, the patient rapidly progressed to multiple organ dysfunction and had a poor prognosis. She had no known exposure to ticks or other animals, raising strong suspicion of SFTSV transmission through the weasel bite. Conclusion This is the first reported case of SFTS possibly linked to a M. sibirica bite, offering novel insight into potential alternative zoonotic transmission routes of SFTSV. These findings highlight the urgent need for surveillance of animal hosts in endemic regions to better understand transmission pathways.

Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) pose significant threats to patient outcomes, frequently resulting in multiple organ dysfunction syndrome (MODS) and elevated mortality rates. This study investigates MODS outcomes among ALF and ACLF patients in China, identifying key factors that influence mortality and prognosis. A retrospective cohort analysis was conducted at a specialized tertiary hospital in Beijing, covering the period from June 2009 to May 2022, which included 585 patients:195 with ALF and 390 with ACLF. Among these, 61

Abstract Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) pose significant threats to patient prognosis, often leading to multiple organ dysfunction syndrome (MODS), which is characterized by simultaneous dysfunction of two or more organ systems and significantly heightens the risk of mortality. Standard strategies for managing organ complications in critical illness may not always be suitable for patients with liver failure (LF).This study aims to investigate the outcomes of MODS in patients with ALF and ACLF in China, while also identifying factors influencing mortality and prognosis. We conducted a retrospective cohort study at a specialized tertiary hospital for liver diseases in Beijing, China, spanning from June 1, 2009, to May 31, 2022.Risk factors were assessed through univariate and multivariate analyses using logistic regression. Cumulative 90-day mortality rates between the ACLF and ALF groups were compared using Cox Analysis. 195 patients with ALF and 318 patients with ACLF were included in this study. The primary outcome of interest was 90-day mortality. This study enrolled a total of 513 patients. Of these, 119 patients (61%) with ALF and 140 patients (44%) with ACLF experienced MODS. Patients with ALF exhibited a higher number of organ failures compared to those with ACLF (2 vs. 1, P = 0.006). Additionally, patients with ALF demonstrated higher median admission critical illness scores.Multivariate logistic analysis indicated that GIB (OR = 3.112, 95% CI 1.4–6.916, P = 0.005), MELD-Na scores (OR = 1.079, 95% CI 1.033–1.127, P = 0.001), Age (OR = 1.056, 95% CI 1.025–1.088, P < 0.001), NLR (OR = 1.073, 95% CI 1.014–1.132, P = 0.014), ICU admission (OR = 4.319, 95% CI 1.347–13.851, P = 0.014), and Clif-SOFA (OR = 1.147, 95% CI 1.022–1.287, P = 0.02) were independent influential factors in predicting 90-day mortality, with an AUCROC of 0.881. Multivariate logistic analysis revealed that SOFA score (OR = 1.255, 95% CI 1.166–1.351, P = 0.001), GCS scores (OR = 0.674, 95% CI 0.606–0.881, P = 0.001), Age (OR = 1.048, 95% CI 1.022–1.076, P < 0.001), and ICU admission (OR = 0.258, 95% CI 0.075–0.885, P = 0.031) were independent influential factors in predicting 90-day mortality, with an AUCROC of 0.872.Cox analysis for cumulative 90-day mortality indicated that patients with ALF had higher mortality rates compared to those with ACLF (33.8% vs. 27%, P = 0.026) and compared to patients with cirrhosis ACLF and non-cirrhosis ACLF (33.8% vs. 31% vs. 25.9%, P = 0.018).Patients with ALF exhibited a higher incidence of MODS and consequently had a poorer 90-day prognosis.

BackgroundCitrate refers to an anticoagulant agent commonly used in extracorporeal organ support. Its application is limited in patients with liver failure (LF) due to the increased risk of citrate accumulation induced by liver metabolic dysfunction. This systematic review aims to assess the efficacy and safety of regional citrate anticoagulation in extracorporeal circulation for patients with liver failure.MethodsPubMed, Web of Science, Embase, and Cochrane Library were searched. Studies regarding extracorporeal organ support therapy for LF were included to assess the efficacy and safety of regional citrate anticoagulation. Methodological quality of included studies were assessed using the Methodological Index for Non-randomized Studies (MINORS). Meta-analysis was performed using R software (version 4.2.0).ResultsThere were 19 eligible studies included, involving 1026 participants. Random-effect model showed an in-hospital mortality of 42.2% [95%CI (27.2, 57.9)] in LF patients receiving extracorporeal organ support. The during-treatment incidence of filter coagulation, citrate accumulation, and bleeding were 4.4% [95%CI (1.6-8.3)], 6.7% [95%CI (1.5-14.4)], and 5.0% [95%CI (1.9-9.3)], respectively. The total bilirubin(TBIL), alanine transaminase (ALT), aspartate transaminase(AST), serum creatinine(SCr), blood urea nitrogen(BUN), and lactate(LA) decreased, compared with those before the treatment, and the total calcium/ionized calcium ratio, platelet(PLT), activated partial thromboplastin time(APTT), serum potential of hydrogen(pH), buffer base(BB), and base excess(BE) increased.ConclusionRegional citrate anticoagulation might be effective and safe in LF extracorporeal organ support. Closely monitoring and timely adjusting during the process could reduce the risk for complications. More prospective clinical trials of considerable quality are needed to further support our findings.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022337767.

Objective To investigate the expression and significance of BMP7/Smads signaling pathway in hepatic fibrosis tissues induced by common bile duct ligation in rats.Methods Male Wistar rats were simple randomizationally divided into sham operation group,common bile duct ligation group for 7days group,14days group,28days group and 42days group.Common bile duct ligation meth-od was used to establish the cholestatic hepatic fibrosis animal model.hematoxylin-eosin staining and Masson staining were used to ob-serve the hepatic tissues morphology and collagen deposition of the rats in each group.Real-time quantitative polymerase chain reaction(RT-qPCR)technology was used to detect the mRNA expression of hepatic fibrosis indicators,such as α-smooth muscle actin(α-SMA)and fibronectin(FN)in each group.Immunohistochemistry was used to determine the deposition of collagen Ⅰ in the hepatic tis-sues,Western blot was used to detect the proteins expression of FN,collagen Ⅰ,collagen Ⅲ,α-SMA and tissue inhibitor of matrix metalloproteinase(TIMP1)in the hepatic tissues.The expression and localization of BMP-7 and p-Smad1/5/8 proteins in the hepatic tissues were detected by Western blot and Immunohistochemistry.Results Compared with the sham operation group,with the extension of common bile duct ligation time,the degree of hepatic fibrosis gradually increased,the intrahepatic collagen hyperplasia was obvious,and thick fibrous septum were obviously formed in the hepatic issues of BDL groups.The expression of FN,α-SMA,collagen Ⅰ,colla-gen Ⅲ and TIMP1 proteins in the BDL hepatic tissues were significantly increased,the difference were statistically significant(P<0.05).In the hepatic fibrosis tissue,the expression of BMP-7 and p-Smad1/5/8 proteins were significantly increased in the early stage of hepatic fibrosis,while which were decreased with the aggravation of hepatic fibrosis.Compare with the sham operation group,the difference was statistically significant(P<0.05).Conclusion The BMP-7/Smads signaling pathway is significantly activated in the early stage of hepatic fibrosis in rats,which exerted protective effect on bile duct ligation-induced hepatic fibrosis.However,the protec-tive effect of activation of BMP-7/Smads signaling pathway was inhibited with the progression of hepatic fibrotic severity.

Objective:To explore the clinical efficacy and safety of Nirmatrelvir/Ritonavir in retreatment for patients with recurrence of coronavirus disease 2019 (COVID-19).Methods:The COVID-19 patients hospitalized in Beijing Ditan Hospital, Capital Medical University and received Nirmatrelvir/Ritonavir therapy from April 17 to June 17 2022 were investigated and the clinical data were analyzed.Results:The retreatment with Nirmatrelvir/Ritonavir for the patients with recurrence of COVID-19 remained effective. The median value of time from the start of retreatment to negative conversion of nucleic acid was 8 (7-10) days. None of the patients showed adverse drug reaction.Conclusions:No drug-related adverse reaction was observed within the treatment course of Nirmatrelvir/Ritonavir and the therapy may be beneficial to shorten hospitalization and quarantine.

Background: Acute respiratory failure (ARF) remains the most common diagnosis for intensive care unit (ICU) admission in acquired immunodeficiency syndrome (AIDS) patients. Methods: We conducted a single-center, prospective, open-labeled, randomized controlled trial at the ICU, Beijing Ditan Hospital, China. AIDS patients with ARF were enrolled and randomly assigned in a 1:1 ratio to receive either high-flow nasal cannula (HFNC) oxygen therapy or non-invasive ventilation (NIV) immediately after randomization. The primary outcome was the need for endotracheal intubation on day 28. Results: 120 AIDS patients were enrolled and 56 patients in the HFNC group and 57 patients in the NIV group after secondary exclusion. Pneumocystis pneumonia (PCP) was the main etiology for ARF (94.7%). The intubation rates on day 28 were similar to HFNC and NIV (28.6% vs. 35.1%, p = 0.457). Kaplan–Meier curves showed no statistical difference in cumulative intubation rates between the two groups (log-rank test 0.401, p = 0.527). The number of airway care interventions in the HFNC group was fewer than in the NIV group (6 (5–7) vs. 8 (6–9), p < 0.001). The rate of intolerance in the HFNC group was lower than in the NIV group (1.8% vs. 14.0%, p = 0.032). The VAS scores of device discomfort in the HFNC group were lower than that in the NIV group at 2 h (4 (4–5) vs. 5 (4–7), p = 0.042) and at 24 h (4 (3–4) vs. 4 (3–6), p = 0.036). The respiratory rate in the HFNC group was lower than that in the NIV group at 24 h (25 ± 4/min vs. 27 ± 5/min, p = 0.041). Conclusions: Among AIDS patients with ARF, there was no statistical significance of the intubation rate between HFNC and NIV. HFNC had better tolerance and device comfort, fewer airway care interventions, and a lower respiratory rate than NIV. Clinical Trial Number: Chictr.org (ChiCTR1900022241).

Objective: We performed a comparative analysis of respiratory function and hemodynamics among patients with Acquired Immunodeficiency Syndrome (AIDS)-associated respiratory failure and those with non-AIDS-associated respiratory failure.Methods: Data were collected from critically ill patients diagnosed with Acquired Immunodeficiency Syndrome who were admitted to the Intensive Care Unit (ICU) of Beijing Ditan Hospital, affiliated with Capital Medical University, between January 1, 2019, and December 31, 2019. We simultaneously gathered data from non-AIDS patients admitted to the ICU of Beijing Liangxiang Hospital within the same timeframe. A comparative study was performed to analyze clinical data from these two patient groups, encompassing parameters related to respiratory mechanics and hemodynamic indicators.Results: A total of 12 patients diagnosed with Acquired Immunodeficiency Syndrome (AIDS) and experiencing respiratory failure, along with 23 patients with respiratory failure independent of AIDS, were included in our study. Subsequently, a comparative analysis of clinical information was conducted between the two patient cohorts. Our findings demonstrate non-statistically significant differences between the two patient groups when assessing various indicators, encompassing peak airway pressure, plateau pressure, mean pressure, compliance, oxygenation index, and arterial partial pressure of carbon dioxide (P>0.05). Additionally, the comparison of multiple indicators encompassing mean arterial pressure, central venous pressure, cardiac output index, intrathoracic blood volume index, global end-diastolic volume index, extravascular lung water content, and pulmonary vascular permeability index revealed no statistically significant differences between the two patient groups (P>0.05). Ultimately, the Galileo respiratory system was utilized to assess the pressure-volume (P-V) curve of the experimental cohort, revealing a consistent and seamless trajectory devoid of noticeable points of inflection.Conclusion: No statistically significant differences were found in the respiratory function and hemodynamic profiles between patients diagnosed with AIDS presenting respiratory failure and those experiencing respiratory failure unrelated to AIDS. Additionally, the pressure-volume curve of individuals diagnosed with AIDS presenting respiratory failure displayed a seamless and uninterrupted trajectory devoid of discernible points of inflection. Hence, there might be constraints when utilizing P-V curve-based adjustments for positive end-expiratory pressure (PEEP) during mechanical ventilation in individuals diagnosed with AIDS presenting respiratory failure.

Objective:To investigate the clinical efficacy of high-flow nasal cannula (HFNC) oxygen therapy as the respiratory support for severe coronavirus disease 2019 (COVID-19) patients, and to analyze the risk factors of HFNC oxygen therapy failure in the treatment of severe COVID-19.Methods:A retrospective analysis was performed on the clinical data of patients who received HFNC oxygen therapy and met the criteria for severe COVID-19 in the Department of Intensive Care Medicine, Beijing Ditan Hospital, Capital Medical University from January 2020 to June 2020. Patients were divided into HFNC success group and HFNC failure group according to applying non-invasive/invasive positive pressure ventilation or not in the following treatment. T test or chi-square test were used to compare the differences between the two groups in basic data, APACHEII score, laboratory data, basic oxygenation index, time from onset to HFNC usage, baseline ROX index, and respiratory rate, oxygenation index and ROX index at 2, 4 and 12 hours after HFNC treatment. The risk factors of HFNC treatment failure were then analyzed.Results:A total of 40 patients were enrolled in the clinical study. Twenty-one patients (52.5%) successed in HFNC treatment and 19 patients (47.5%) failed. There were no significant differences between the success group and failure group in basic data, laboratory data, basal oxygenation index, time from onset to HFNC use, baseline ROX index, respiratory rate and oxygenation index at 2 h, 4 h and 12 h after HFNC treatment ( P>0.05). There were significant differences between the two groups in APACHEII score and ROX index at 2h, 4h and 12h after HFNC treatment ( P<0.05). Logistic regression analysis showed that APACHEII score and ROX index were independent risk factors for HFNC treatment failure. Conclusions:HFNC can be used as the respiratory support for severe COVID-19, and ROX index monitoring was a key factor in evaluating the success of HFNC treatment.

Objective:To analyze the adult cases of Japanese encephalitis admitted to Beijing Ditan Hospital in 2018, so as to explored the clinical features and prognosis and improve the current understanding and treatment of Japanese encephalitis.Methods:The clinical data and the results of 3-year follow-up of adult Japanese encephalitis cases admitted to Ditan Hospital between August 2018 and September 2018 were analyzed retrospectively. The clinical symptoms, physical signs, results of laboratory testing and cerebrospinal fluid examination of the patients of different severity levels were compared. The follow-up patients were divided into good prognosis and poor prognosis groups based on the modified RANK score, and the influencing factors of prognosis were analyzed.Results:A total of 21 patients were enrolled in this study, including 12 patients in common group and 9 patients in sever group. The proportions of complication with underlying diseases, respiratory disorders, pulmonary infection, epilepsy, disturbance of consciousness, as well as the values of Neutrophil/Lymphocyte ratio (NLR), C-reactive protein, and cerebrospinal fluid pressure in severe groups were all statistically higher than those in common group (all P<0.05). During hospitalization, severe patients showed more obvious changes in body temperature, white blood cell count, neutrophil percentage and GCS score. During the 3-year follow-up period, 4 patients were lost to follow-up, and 6 of 17 patients died, with a fatality rate of 35.3%. Nine patients had good prognosis and 8 patients had poor prognosis. Univariate logistic regression analysis showed that GCS score >13 on admission was a protective factor for the prognosis of patients with Japanese encephalitis. Conclusions:Adult Japanese encephalitis patients with underlying diseases, or complicated with pulmonary infection and neurological symptoms, and with increased cerebrospinal fluid pressure indicated possible severe conditions. GCS score >13 on admission could be a protective factor for patients with Japanese encephalitis and can be used to evaluate the prognosis.

BACKGROUND The Fontan operation is the only treatment option to change the anatomy of the heart and help improve patients’ hemodynamics. After successful operation, patients typically recover the ability to engage in general physical activity. As a better ventilatory strategy, extracorporeal membrane oxygenation (ECMO) provides gas exchange via an extracorporeal circuit, and is increasingly being used to improve respiratory and circulatory function. After the modified Fontan operation, circulation is different from that of patients who are not subjected to the procedure. This paper describe a successful case using ECMO in curing influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago. The special cardiac structure and circulatory characteristics are explored in this case. CASE SUMMARY We report a successful case using ECMO in curing influenza A infection in a 23-year-old man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago. The man was admitted to the intensive care unit with severe acute respiratory distress syndrome as a result of influenza A infection. He was initially treated by veno-venous (VV) ECMO, which was switched to veno-venous-arterial ECMO (VVA ECMO) 5 d later. As circulation and respiratory function gradually improved, the VVA ECMO equipment was removed on May 1, 2018. The patient was successfully withdrawn from artificial ventilation on May 28, 2018 and then discharged from hospital on May 30, 2018. CONCLUSION After the modified Fontan operation, circulation is different compared with that of patients who are not subjected to the procedure. There are certainly many differences between them when they receive the treatment of ECMO. Due to the special cardiac structure and circulatory characteristics, an individualized liquid management strategy is necessary and it might be better for them to choose an active circulation support earlier.

目的:人感染猕猴α疱疹病毒1型是罕见的人畜共患病，2021年4月，在中国北京一位实验动物饲养员出现发热、皮疹、行走无力等症状，后被诊断为人感染猕猴α疱疹病毒1型，病毒性脑脊髓炎，为我国首例人感染猕猴α疱疹病毒1型病患。这名患者在入院前出现心脏呼吸骤停，诊断为缺血缺氧性脑病并出现坏死性病毒性脑脊髓炎，住院期间脑功能损害逐渐加重，临床判定脑死亡，在患者入院39 d，病程第51 d，家属撤除治疗。

自2020年1月12日收治第一例新冠肺炎患者以来,首都医科大学附属北京地坛医院就一直坚守在抗击新冠肺炎疫情的阵地上.而重症监护病房(ICU)收治了绝大多数的危重症患者,这里是守护患者生命的最后一道防线.

新型冠状病毒肺炎( COVID-19 )疫情在国内已经得到有效控制,但其他国家和地区仍呈增长态势[1].目前研究[2]显示,COVID-19 疫情的病原体新型冠状病毒主要损伤肺部,同时也可造成全身多脏器损伤,表现出广泛损伤的特点.急性胰腺炎( acute pancrea-titis,AP)是消化系统常见的危重疾病,发病率逐年升高,已成为严重危及我国人民健康和生命的重大疾病之一.尽管目前新型冠状病毒肺炎病例数量巨大,但目前仅有少量的报道[3]观察到合并急性胰腺炎.在COVID-19大流行中,首都医科大学附属北京地坛医院收治了北京市首例重症新型冠状病毒肺炎合并急性胰腺炎病例,经治疗后痊愈出院.为总结经验,提高救治水平,现将本例患者资料报道如下.

We reported that the complete genome sequence of SARS-Coronavirus-2 (SARS-CoV-2) was obtained from a cerebrospinal fluid (CSF) sample by ultrahigh-depth sequencing. Fourteen days after onset, seizures, maxillofacial convulsions, intractable hiccups and a significant increase in intracranial pressure developed in an adult coronavirus disease 2019 patient. The complete genome sequence of SARS-CoV-2 obtained from the cerebrospinal fluid indicates that SARS-CoV-2 can invade the central nervous system. In future, along with nervous system assessment, the pathogen genome detection and other indicators are needed for studying possible nervous system infection of SARS-CoV-2.

Background: The Fontan operation is the only treatment option to change the anatomy of the heart and help improve patients’ hemodynamics. After successful operation, patients typically recover the ability to engage in general physical activity. The mortality of patients diagnosed with acute respiratory distress syndrome (ARDS) ranges from 17.3 to 41.4% among critically ill patients with H1N1 infection. As a better ventilatory strategy, extracorporeal membrane oxygenation (ECMO) provides gas exchange via an extracorporeal circuit, and is increasingly being used to improve respiratory and circulatory function. As is known to all, after the modified Fontan operation, circulation was different compared with patients who were not subjected to the procedure. But very few articles describe the special circulation about the case who was post-operative of the modified Fontan operation especially when it received the treatment of E-CMO. This study aims to describe a successful case using E-CMO in curing the influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation thirteen years ago. We want to explore the special cardiac structure and circulatory characteristics in this case. Methods: To report a successful case using extracorporeal membrane oxygenation in curing the influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation thirteen years ago. In this article, we describe a 23-year-old man, with a history of modified Fontan operation for the Tausing-Bing syndrome, admitted to ICU with severe acute respiratory distress syndrome as a result of influenza A infection. The man was initially treated by V-V ECMO, five days later was switched to V-V-A E-CMO. Results: As circulation and respiratory function gradually improved, the VV-A ECMO equipment was removed on May 1, 2018.The patient was successfully withdrawn from artificial ventilation on May 28, 2018, then discharged from hospital on May 30, 2018. Conclusion: After the modified Fontan operation, circulation was different compared with patients who were not subjected to the procedure. There were certainly many differences between the two sides when they received the treatment of E-CMO. As the special cardiac structure and circulatory characteristics, an individualized liquid management strategy was necessary and it might be better for them to choose an active cycle support earlier.

Objective:To evaluate the application value of serum amyloid A (SAA) and C-reactive protein (CRP) in the monitoring the status of coronavirus disease 2019 (COVID-19).Methods:The clinical data of COVID-19 patients admitted to the Department of Intensive Medicine and Infection Center of Beijing Ditan Hospital affiliated to Capital Medical University from January 20 to June 29, 2020 were retrospective analyzed, including 147 cases in mild group and 75 cases in severe group. The differences between SAA and CRP at each time point between the two groups and the prediction value for severe COVID-19 were analyzed.Results:The average ages of the severe and mild cases were 57.2±16.8 and 35.9±17.4 years old, respectively and the difference was statistically significant ( P<0.05). The proportions of male cases in severe and mild groups were 62.7% and 48.3%, respectively and the difference was statistically significant ( P<0.05). For underlying diseases, the proportion of patient with diabetes in severe and mild groups were 25.3% and 2.7%, respectively and the difference was statistically significant ( P<0.05); the proportion of patient with hypertension in severe and mild groups were 37.3% and 17.0%, respectively and the difference was statistically significant ( P<0.05). The average hospitalization time in severe and mild groups were 31.5±10.2 days and 24.5±13.8 days, respectively and the difference was statistically significant ( P<0.05). The levels of CRP and SAA at the 0, 3, 7 and 14 days after admission in severe were higher than those in mild group. In ROC analyses of the prediction values, the area under curve (AUC) of CPR at the 0, 3, 7 and 14 days after admission for severe COVID-19 were 0.923, 0.918, 0.945 and 0.776 respectively, while AUCs of SAA at the above time points were 0.807, 0.795, 0.864 and 0.762, respectively. CRP level above 27.85mg/dL at 0 day and 45.25mg/dL at 3 days after admission can predict the occurrence of severe illness in patients. SAA level above 66.0mg/dL at 0 day and 267.35 mg/dL at 3 days after hospitalization can predict the occurrence of severe illness in patients. Conclusions:Regular testing of SAA and CRP would be helpful for the judgment of disease severity and the prediction of disease development and can be applied in clinical practice.

Hebing Guo Capital Medical University Jianbo Tan Capital Medical University Yongchao Cui Capital Medical University Haofeng Xiong Capital Medical University Chuansheng Li Capital Medical University Yufeng Liu Capital Medical University Yao Sun Capital Medical University Lin Pu Capital Medical University Pan Xiang Capital Medical University Ming Zhang Capital Medical University Jingjing Hao Capital Medical University Ningning Yin Capital Medical University Xiaotong Hou Capital Medical University Jingyuan Liu (  dtyyicu@ccmu.edu.cn ) Capital Medical University https://orcid.org/0000-0002-0592-9789

Background: AKI is a common complication among human immunodeficiency virus (HIV)--infecting patients and resulting in increased morbidity and mortality. CRRT is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in ICU and explore the influence factors correlated with CRRT and prognosis. Methods: We performed a retrospective case-control study, in ICU of Beijing Ditan Hospital Capital Medical University, which is a top three hospital majoring in infectious diseases. From June 1,2005 to May 31,2017, 225 cases were enrolled in this research eventually. Results: 122(54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1/2/3 were respectively 38(31.1%)/23(18.9%)/61(50%). 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By multivariate logistics analysis, it showed that the use of vasoactive agents (OR=174.31,95% CI 1.743-65.271, p=0.018), diagnosis of PCP(OR=27.136,95% CI 1.855-397.066, p=0.016) and longer duration of CRRT (OR=1.034,95% CI 1.004-1.065, p=0.028) were independent risk factors for predicting patients’ death of CRRT in ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p =0.309). Conclusions: The incidence of AKI was 54.2% in HIV-infected patients admitted to the ICU, and about 26.2% AKI patients received CRRT during the stay of ICU.56.25%CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. The use of vasoactive agents, diagnosis of PCP were independent risk factors for predicting patients’ death of CRRT in ICU. The cumulative survival of AKI 3 patients between CRRT and non-CRRT groups shows no significant differences.